The COMPACT™: An OT Assessment Tool to Support Practice Ideals

Jan Stube, PhD, OTR/L, FAOTA & Debra Hanson, PhD, OTR/L, FAOTA

Photo credit: Wunkai via Foter.com / CC BY-NC-SA

Photo credit: Wunkai via Foter.com / CC BY-NC-SA

Introduction:

The Collaborative Occupational Measure of Performance and Change over Time (COMPACT) is designed to promote best practice ideals in occupational therapy (OT) – client-centered and occupation-focused intervention. This includes a focus on occupational goals that are valued by the client and caregiver, objective assessment of occupational performance, and collaborative goal setting that sets the stage for client engagement in the therapy process (Aiken, Fourt, Cheng & Polatajko, 2011). Why is this important? Clients and caregivers who do not actively participate in the goal setting process or who are not aware of their (client) goals are not as invested in the therapy process, slowing therapy progress (Colaianni & Provident, 2010; Maitra & Erway, 2006).  Maintaining the focus of OT intervention on occupation rather than underlying impairment is most motivating to the client and a stimulant to therapy progress (Blaga & Robertson, 2008; Moats, 2007; Palmadottir, 2006; Smallfield & Karges, 2011). Predictably, client satisfaction, an important consideration for medical reimbursement, is enhanced.  Similarly, caregivers who are informed of their family member’s condition and engaged in the therapy process are better able to participate responsibly in discharge planning than those who are not involved, or engaged late in the rehabilitation process (Bright et al., 2012; Gustafsson et al., 2010.

Description of the COMPACT™:

Based on the AOTA’s OT Practice Framework – 3rd edition (2014), the client’s (or patient’s) perspective on their occupational participation is at the heart of the COMPACT instrument. Provided in an easy-to-use checklist format, the COMPACT™ consists of three forms:

Form A reflects the perspective of the patient and the caregiver in regard to previous pattern of occupational performance, current difficulties in activity participation and priorities for occupational therapy intervention.

Form B is designed to re-assess the priorities of the patient and caregiver in response to therapy progress. Through form use, 1) the patient and his or her perspectives of skill level in occupational performance are now rated, and 2) the patient and caregiver’s perspectives of priorities for future occupational therapy intervention are identified.

Form C provides a format for gathering together the perspectives of the patient, the caregiver and the therapist for collaborative goal-setting. It provides 1) a record of the patient and caregiver priorities, 2) therapist ratings of objective performance in areas of occupation (using relevant observation-based assessment tools), and 3) a format for identifying goals derived from analysis of patient and caregiver priorities and objective performance ratings.

Overall, the COMPACT™ is intended for use as a tool to facilitate ongoing communication between the patient, the caregiver and the therapist over time. This enables client-centered treatment planning responsive to objective measurement of occupational competency.

Method/Process

The initial version of the COMPACT™ tool was reviewed by a panel of occupational therapy experts from across practice areas who verified the tool’s value. Preparation for pilot testing in clinical settings was next, and involved editing the forms for clinical usage and development of an administration manual. Receiving university institutional review board approval and copyright and trademark filing through University of North Dakota followed.

A three-month pilot testing phase of the COMPACT™ tool then occurred across two Midwestern U.S. physical rehabilitation health systems, both inpatient and outpatient settings. Using convenience sampling, 20 experienced OT practitioners were recruited for study participation. They, in turn, recruited 18 client participants for COMPACT™ data gathering.

The mixed methods research design used for the pilot study included data gathering from both OT and client participant groups. Focus groups with OT practitioners yielded feedback (formal and audiotaped) regarding the process and experiences of using the assessment tool (qualitative information). This was combined with the clients’ completion of the COMPACT™ tool (quantitative data) to complete the pilot testing research phase.

Descriptive client participant data was collected via the COMPACT™ forms using SPSS, v.21. Qualitative data from the focus group was coded and analyzed for emerging patterns and themes.

Results & Summary

All focus group OT practitioner participants agreed regarding the value, face validity and content validity of the COMPACT™.  Client data supported face and content validity by their ability to select occupations of importance to them (100%) and to self-rate five occupations as priorities for intervention in the majority of the cases (83%). An interesting result was that the clients’ self-selected priorities extended beyond ADLs alone; clients selected IADLs along with or instead of ADLs in the majority of cases; this was found across practice settings (acute care, inpatient, and outpatient).

Recommendations included the addition of an acute care COMPACT™ form to limit client choices and minimize the risk of overwhelming medically fragile clients. Additionally, OT practitioners consistently stated that they felt the forms were less appropriate for use with clients with cognitive challenges; this is a consideration for OT practice usage. Although the COMPACT™ is designed for use with caregivers as well as the client receiving direct care, only two caregivers participated in the pilot study. The inclusion of caregivers in client-centered occupational priority intervention planning is recommended for further research.

What’s Next

In response to positive feedback from our pilot study regarding the clinical value, face validity, and initial content validity of the COMPACT™ tool, we revised the forms and administration manual and published the tool on the University of North Dakota’s Department of Occupational Therapy website, http://www.med.und.edu/occupational-therapy/. We invite readers to view the COMPACT™ and, if interested, to contact us regarding: 1) what they find valuable/important or challenging about the COMPACT™ tool as they use it in practice; and 2) their interest in participation with us in a multi-site research trial.

 

Author Biographies:

Jan Stube, PhD, OTR/L, FAOTA is a professor in the Department of Occupational Therapy, University of North Dakota, Grand Forks, ND. Her research interests are in the areas of physical disabilities practice, including neurorehabilitation, and the scholarship of teaching and learning in higher education.

Debra Hanson, PhD, OTR/L, FAOTA is a professor and academic fieldwork coordinator in the Department of Occupational Therapy, University of North Dakota, Grand Forks, ND. Her research interests include fieldwork education, professional identity, and application of best practice ideals.

References

Aiken, F., Fourt, A., Cheng, I.K.S., & Polatajko, H.J. (2011). The meaning gap in occupational therapy: Finding meaning in our own occupation. Canadian Journal of Occupational Therapy, 78(5), 294 – 302.

American Occupational Therapy Association (AOTA). (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1-S48. http://dx.doi.org/10.5014/ajot.2014.682006.

Blaga, L., & Robertson, L. (2008). The nature of occupational therapy in acute physical care settings. New Zealand Journal of Occupational Therapy, 55, 11 – 18.

Bright, F.A.S., Boland, Pl, Rutherford, S.J., Kayes, N.M., & McPherson, K.M. (2012). Implementing a client-centred approach in rehabilitation: An autoethnography. Disability and Rehabilitation, 34, 997 – 1004. DOI:10.3109/09638228.2011.629712

Colaianni, D., & Provident, I. (2010). The benefits of and challenges to the use of occupation in hand therapy. Occupational Therapy in Health Care, 24(2), 130 – 146.

Gustafsson, L., Hodge, A., Tobinson, M., McKenna, K., & Bower, K. (2010). Information provision to clients with stroke and their carers: Self-reported practices of occupational therapists. Australian Occupational Therapy Journal, 57, 190 – 196.

Maitra, K., & Erway, F. (2006). Perception of client-centered practice in occupational therapists and their clients. The American Journal of Occupational Therapy, 60(3), 298 – 310.

Moats, G. (2007). Discharge decision-making, enabling occupations, and client-centred practice. Canadian Journal of Occupational Therapy, 74(2), 91 – 101.

Palmadottir, G. (2006). Client-therapist relationships: Experiences of occupational therapy clients in rehabilitation. British Journal of Occupational Therapy, 69(9), 394 – 401.

Smallfield, S., & Karges, J. (2009). Classification of occupational therapy intervention for inpatient stroke rehabilitation. American Journal of Occupational Therapy, 63, 408 – 413.

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